eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Pregnancy, Eclampsia: Follow-up

Author: Allysia M Guy, MD, Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
Coauthor(s): Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Contributor Information and Disclosures

Updated: Aug 11, 2009

Follow-up

Further Inpatient Care

  • Patients with eclampsia require immediate obstetric consultation and admission to an intensive care setting for supportive care and treatment until delivery of the neonate.
  • Patients require hospitalization, with bed rest in left lateral decubitus position.
  • Airway management and adequate oxygenation should be continued.
  • Anticonvulsant therapy with magnesium sulfate may be required.
  • Treat continued hypertension with hydralazine or labetalol.
  • Delivery of the neonate is the definitive treatment.

Transfer

  • Perinatal morbidity and mortality rates vary in relation to the level of care rendered by the medical center. Patients with eclampsia require transfer to a high-risk obstetric facility that provides neonatal and maternal intensive care.
  • When initially evaluating a patient with eclampsia, become familiar with the level of care that the medical center can offer the patient.

Deterrence/Prevention

  • High protein, low salt diet2
  • Protein supplementation
  • Magnesium
  • Calcium
  • Zinc
  • Fish and evening primrose
  • Antihypertensive drugs
  • Antithrombotic agents
  • Low-dose aspirin
  • Dipyridamole
  • Heparin
  • Vitamins E an C

Note: Studies have not been able to prove risk benefits of most of these preventative measures; thus, they are not recommended as prophylaxis at this time.2

Complications

  • Permanent neurologic damage from recurrent seizures or intracranial bleeding
  • Studies suggest increased risk for CVA and CAD in eclamptic mothers later in life.1
  • Renal insufficiency and acute renal failure
  • Fetal changes - IUGR, abruptio placentae, oligohydramnios
  • Hepatic damage and rarely hepatic rupture
  • Hematologic compromise and DIC
  • Increased risk of recurrent preeclampsia/eclampsia with subsequent pregnancy4
  • Death

Prognosis

  • Approximately 25% of women with eclampsia have hypertension in subsequent pregnancies.
  • Eclamptic multiparous women may have an increased risk for essential hypertension.
  • Eclamptic multiparous women have an increased mortality rate in subsequent pregnancies compared with primiparous women.

Miscellaneous

Medicolegal Pitfalls

  • Preeclampsia can progress quickly to eclampsia.
  • Immediately consult an obstetrician/gynecologist when the diagnosis of eclampsia is being considered.
  • Seizures in the first trimester or well into the postpartum period probably are due to CNS pathology and warrant full evaluation, including CT scanning of the head, lumbar puncture (if clinical evidence of meningitis or concern for hemorrhage exists), determination of electrolyte levels, and urine or serum toxicologic screening.
  • Preventing the development of preeclampsia in high-risk patients could theoretically decrease the risk of eclampsia and its complications later in pregnancy. Aspirin blocks platelet aggregation and vasospasm in preeclampsia, and it may be effective in preventing preeclampsia. Recent studies have shown that low-dose aspirin in women at high risk for preeclampsia can contribute to a decreased risk of preeclampsia, a reduction in preterm delivery rates, and a reduction in fetal death rates without increasing the risk of placental abruption. An obstetrician should directly supervise aspirin therapy in high-risk patients.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Stephen Morris, MD, to the development and writing of this article.



More on Pregnancy, Eclampsia

Overview: Pregnancy, Eclampsia
Differential Diagnoses & Workup: Pregnancy, Eclampsia
Treatment & Medication: Pregnancy, Eclampsia
Follow-up: Pregnancy, Eclampsia
References
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References

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Further Reading

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Keywords

eclampsia, hypertension of pregnancy, seizures in pregnancy, toxemia of pregnancy, coma in pregnancy, preeclampsia, hypertensive disorder, proteinuria

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Contributor Information and Disclosures

Author

Allysia M Guy, MD, Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System
Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Medicines Company Consulting fee Consulting; Pfizer Salary Employment

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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